What Works briefing on natural environment based health interventions
2019 : Becca Lovell (1) , Ben Wheeler (1) , Kerryn Husk (2) , Kathryn Machray (3), and Mike Depledge1 (1)University of Exeter Medical School, (2)NIHR CLAHRC South West Peninsula, Plymouth University Peninsula Schools of Medicine and Dentistry, (3)MRC/CSO Social and Public Health Sciences Unit, University of Glasgow
The UK faces considerable health challenges including rising rates of non-communicable diseases , chronic disability and persistent socio-economic related inequalities in health outcomes and their contributory risk factors such as low levels of physical activity. A growing body of evidence suggests that the use of natural environment is associated with better health outcomes and may potentially be of value as a resource in tackling some of our most intractable health issues [2, 3]. There is increasing interest as to how the natural environment could be utilised as a health promotion tool, setting or context in which to address the increasing burden of health problems. Many types of natural environment - from the National Parks, with their protected environments with high levels of biodiversity and culturally important spaces, to urban greenspaces, close to large populations offering spaces for physical activity and stress relief - could have a role in public health promotion or as a therapeutic setting. As of yet there have been few attempts to draw together and synthesise evidence specifically relating to which natural environment based health interventions work, for whom, in what circumstances, and why. Similarly, there has been little effort to map provision, identify systems through which interventions can be most effectively delivered, or to identify cost-effective approaches. This report for Defra, completed in 2018, provides a scoping review of ‘what works’ in nature based health interventions.
..... What works in nature based health intervention design, implementation and delivery
Project evaluations and reports provide some indications of effective approaches to intervention design, implementation and delivery. Key evidence based factors include: making use of theory based intervention design; building on best practice in formal public health intervention design and implementation; appropriate targeting of interventions; engaging communities in intervention design and delivery; flexibility in design and delivery; embedding the intervention within wider provision; making use of behaviour change approaches; and settings based interventions. The outcomes of, and lessons learnt through existing provision, such as the Nature4Health programme, based in the Liverpool region and led by the Mersey Forest  and the four case studies examined for this review (Gardening activities; Birmingham Active parks; Forestry Commission Scotland’s Branching Out programme; and Natural Resources Wales’ Come Outside! Programme) provide helpful guidance on best practice in intervention delivery.
The Nature4Health team identified the following factors as contributing to the success of their interventions :
• Tailoring activities to fit with the local culture
• Projects cannot simply have a physical health focus – social interaction is critical
• Effective monitoring and evaluation is crucial, to inform future delivery and refine projects
• There is a need to be proactive and flexible in delivery
There is currently very little information on the cost-effectiveness of interventions, however the limited available evidence suggests that interventions tend to be cost effective.